Long‐term outcomes of middle‐ear surgery in Aboriginal children

Aboriginal perspective on middle ear disease in the arid zone of Western Australia

“…In general, results of surgery were viewed positively, consistent with results of a recent study in WA 27 . However, there are problems accessing specialist services, partly due to shortage of ENT specialist services in rural areas and partly because people find it difficult or are reluctant to attend hospital appointments 18,28 .…”

Surgery for otitis media among Indigenous Australians

“…Hearing results are more encouraging, with the best controlled study (a prospective case series) showing that normal hearing (defined as an air–bone gap of < 25 dB) was achieved in 69% of patients, improving from 28% preoperatively 37 . In the same study, tympanic membrane closure was achieved in 49% of patients, implying that complete closure of a perforation is not required to achieve good postoperative hearing 37 …”

“…The chronic otitis media observed in Indigenous populations is usually tympanic membrane perforation without ossicular discontinuity, but there is often a degree of middle ear scarring 32 . ‐ 37 Myringoplasty is usually the surgery of choice, but a mild or moderate conductive deficit may persist after successful closure of the tympanic membrane. In children, the age at which surgery is recommended (typically 7–10 years) will depend on patient‐specific factors, including the degree of hearing loss, the morbidity associated with recurrent aural discharge, and the likelihood that the child has outgrown regular bouts of acute otitis media 38 …”

“…Few studies have reported the degree of success of myringoplasty in Indigenous populations, and the interpretation of most studies is complicated by retrospective experimental design, small sample sizes, and high rates of participants lost to follow‐up 32 . ‐ 37 Of patients who are followed up, the success rate of closure of the tympanic membrane perforation is 50%–70%, which is lower than expected when compared with similar surgeries conducted in city‐based hospitals, where 80%–90% is the norm 39 , 40 . Hearing results are more encouraging, with the best controlled study (a prospective case series) showing that normal hearing (defined as an air–bone gap of < 25 dB) was achieved in 69% of patients, improving from 28% preoperatively 37 .…”

“…‐ 37 Of patients who are followed up, the success rate of closure of the tympanic membrane perforation is 50%–70%, which is lower than expected when compared with similar surgeries conducted in city‐based hospitals, where 80%–90% is the norm 39 , 40 . Hearing results are more encouraging, with the best controlled study (a prospective case series) showing that normal hearing (defined as an air–bone gap of < 25 dB) was achieved in 69% of patients, improving from 28% preoperatively 37 . In the same study, tympanic membrane closure was achieved in 49% of patients, implying that complete closure of a perforation is not required to achieve good postoperative hearing 37 …”